Most Canadians still facing longer than expected surgery wait times due to COVID backlog
According to a new report from the Canadian Institute for Health Information (CIHI), hospitals across Canada are performing surgeries at close to pre-pandemic levels, but many patients continue to face longer-than-recommended wait times due to the backlog created by COVID-19.
The report, published on Thursday, looked at knee and hip replacements, cataract surgeries and cancer surgeries performed in 2019 versus those performed in 2022.
Thousands of joint replacement and cataract surgeries were cancelled or delayed when COVID-19 hit.
“Things like knee and hip replacements and cataracts are what we call scheduled surgeries and they were particularly affected during the pandemic because they’re not life-threatening,” said Tracy Johnson, director of health system analytics at CIHI.
“They are very uncomfortable for patients. They cause them more pain. They might even have economic pain. But those are the kinds of things that had to be delayed, especially in the first part of the pandemic when we didn’t know what kind of COVID stuff was going to come at us,” Johnson said.
Those delays created a backlog of surgical procedures that health-care providers still haven’t been able to catch up on.
“The most recent data shows that while the monthly number of scheduled surgeries is nearing pre-pandemic levels, this is insufficient to clear the backlog and improve wait times,” the CIHI report said.
“It also shows that catching up has been more challenging for joint replacement surgeries, which are primarily performed in hospital operating rooms, than for cataract surgeries, which can be done in day procedure rooms or community clinics.”
The longest recommended wait time for knee and hip replacements is six months.
Only half of Canadian patients got their knee replacement surgery within that time frame between April and September 2022, the researchers found. Prior to the pandemic, about 70 per cent of knee replacements were done within the recommended period.
About 57 per cent of hip replacement patients had their surgery in the recommended six-month window in 2022 compared to 75 per cent of patients in 2019.
Cancer surgery wait times haven’t been as dramatically affected because the most urgent cases were prioritized during COVID-19 shutdowns, said Johnson.
Still, during the first several months of the pandemic, there were about 20 per cent fewer cancer procedures performed than before. Those delays and cancellations created the initial backlog, the report said.
Half of patients needing breast, bladder, colorectal and lung cancer surgery waited one to three days longer between April and September 2022 compared to before the pandemic, it said. For patients with prostate cancer, that average wait time jumped to 12 days longer.
Andrea Seale, CEO of the Canadian Cancer Society, said it’s critical for the health-care system to reduce those wait times.
“A day or two might not sound like a lot but it truly is when it comes to cancer because it’s just a disease that cannot wait,” she said.
In a survey of 700 patients and caregivers conducted by the Canadian Cancer Society in November, about a quarter of respondents reported they are still experiencing cancelled or postponed appointments, Seale said.
“Any delay is extremely distressing to people who are facing cancer.”
For cataract surgery, the recommended maximum wait time is 112 days. Although two-thirds of Canadian patients, on average, are getting their surgery within that time frame — the same proportion as before the pandemic — there is “considerable variation” across the provinces, the CIHI report said.
More patients in Newfoundland and Labrador, Quebec and Ontario are waiting longer for cataract surgery, while a higher proportion of patients in B.C., Alberta, Manitoba and P.E.I. are getting their cataract procedures within the recommended 112 days.
Dr. Thomas Forbes, surgeon-in-chief at University Health Network (UHN) in Toronto, said the CIHI report is “valuable” as it highlights patients most affected by surgical backlogs.
“It is really an all-hands-on-deck effort at our hospital and at, I suspect, all other hospitals,” he said.
Forbes agreed with the report’s findings that hospitals have to do even more surgeries than they did before the pandemic to catch up, noting that an aging population increases the demand even more.
UHN has expanded its operating room capacity between 110 and 120 per cent compared to before the pandemic, he said.
That means extending operating room hours during the week, as well as scheduling surgeries on weekends, which had previously been limited to emergencies only.
UHN has also reopened old operating rooms that had been decommissioned, Forbes said.
“Everything is on the table,” he said, including the possibility of transferring patients to a different physician who has a shorter waiting list.
The current staffing shortage, particularly among nurses, is another issue that has to be resolved for hospitals to be able to catch up, Johnson from CIHI said.
“You have a list of people who need surgeries, but you also need people to be able to either perform the surgeries or care for those people post-op,” she said.
Ontario is improving
According to Ontario government website, there are currently 206,000 people estimated to be waiting for surgical procedures. For reference, last fall, there were approximately 209,000 patients waiting for a hospital operating room-based surgical procedure in Ontario, and about 200,000 before the pandemic.
Community surgical and diagnostic centres licensed under the Independent Health Facilities Act currently perform approximately 26,000 OHIP-insured surgeries and procedures annually.
Ontario is investing $300 million in 2022/23 as part of the surgical recovery strategy to increase scheduled surgeries and procedures, as well as appropriate diagnostic imaging services with a focus on areas with the greatest reduction in services due to the COVID-19 pandemic.
Ontario’s surgical recovery strategy prioritizes patients waiting longer than recommended in clinical guidelines. In 2022/23, the government continues to offer premiums to hospitals to support completion of over 200,000 surgeries and procedures.
The government is also investing in digital tools to enhance coordination of surgical services between hospitals and enable better patient flow through the implementation of the Centralized Waitlist Management (CWM) program.
Investments in the CWM program are providing funding for regionally led projects across the province that support a more equitable distribution of surgical cases and reductions in patient wait times, as well as for Ontario Health’s development of the technical infrastructure required to support centralized waitlist management at the provincial level.
Part of the article was reported by CP.